• Reference Number: HEY-630/2018
• Departments: Diabetes
• Last Updated: 31 May 2018

Introduction

This leaflet has been produced to give you general information about your treatment. Most of your questions should have been answered by this leaflet. It is not intended to replace the discussion between you and your healthcare team, but may act as a starting point for discussion.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

The Pancreas

The pancreas is a gland in the abdomen which helps you to digest food and make use of the nutrients. The pancreas has 2 main functions:

1. to aid the breakdown of food ( what we term ‘exocrine function’)
2. to assist the body in making use of the energy derived from food (what we term ‘endocrine function’)

The pancreas secretes digestive enzymes directly into the gut after you have eaten a meal. Enzymes are chemicals which help to break down carbohydrate (starch), proteins and fats from your food into smaller components (nutrients) such as glucose, amino acids and triglycerides (fats). These nutrients are then absorbed from the gut into the blood stream and carried to cells where they act as a source of energy and aid cell repair.

Glucose is the main source of fuel for the body. Glucose however cannot enter the cells from the blood stream on its own. The pancreas has specials cells within in it called the Islets of Langerhans. Within these islets there are beta cells and alpha cells. The beta cells secrete the hormone insulin. Insulin promotes the uptake of glucose from the blood stream into cells where it can be used as energy. Without insulin, glucose levels in the blood stream can rise very high.

The pancreatic alpha cells secrete the hormone glucagon. Glucagon is a hormone that has the opposite action to insulin. Glucagon promotes the release of glucose from the cells back into the blood stream. This is very useful when you are fasting as it prevents blood glucose levels falling too low.  Thus the pancreas balances the secretion of both insulin and glucagon to ensure that blood glucose levels remain stable and within the range for normal body function. All this takes place inside your body without you noticing, however, when the pancreas is removed, this fundamental process of balancing blood glucose cannot occur and requires treatment.

Diabetes and the Pancreas

Diabetes is a condition where the body is unable to maintain a stable blood glucose level independently due to a deficiency of insulin secretion or action. Although you do not necessarily have diabetes now, when you have your pancreas totally removed you will develop diabetes. For patients who are having a partial pancreatectomy how much assistance your body will need to control your blood glucose levels will depend on the amount of pancreas you need to have removed. It may take some time before we, as health professionals, can get the level of treatment exactly right for you, but we will monitor your blood glucose levels after surgery to give us a picture of how your body is responding.

Insulin Treatment

Insulin is one of the hormones that you are likely to be deficient in once your pancreatic surgery is undertaken. Your need for insulin to be administered will depend on the amount of beta cells that get removed/destroyed during your surgery. The beta cells produce insulin and the more that are taken away, the more your body will be reliant on injected insulin.  The hormone insulin is injected into the fat layer just under the skin (subcutaneous tissue) using a tiny needle.

Balancing Act

The most challenging part of having diabetes is getting the balance right between the amount of insulin injected, the amount of carbohydrate you eat and the amount of activity/exercise you do. This will no doubt prove challenging at first but with some education, support and with time this will become easier.

Diet – carbohydrate is the food group that breaks down into glucose and is used by all the body’s cells and converted into energy. Being aware which foods contain carbohydrate and how much will become fundamental to getting your blood glucose level stable. This goes for all carbohydrates (e.g. bread, pasta, rice, cereal), not just sugary foods!

Activity/Exercise – each muscle in your body uses glucose as energy, therefore, the more those muscles work the more glucose they use up, and the less glucose there is circulating in your blood stream needing insulin to counteract it. So if you inject your dose of insulin then do additional activity on top of your normal amount then your blood glucose level may drop too low.

Blood Glucose Levels

Blood glucose (BG) level refers to the level of glucose that is in your blood stream. A safe blood glucose level for you would be between 5 and 10mmol/L. Any reading below 4 we call a ‘hypo’ and any reading in the teens is considered to be a ‘hyper’. These are two terms that you will hear your nurses and doctors referring to. Keeping your level above 4mmol/L will ensure your safety and preventing them from being too high will help prevent any diabetes complications in the future.

After your Surgery

After your surgery you will be visited by a member of the diabetes inpatient team who will work alongside the ward staff to help you achieve good blood glucose control. Immediately after surgery, you may need insulin given intravenously (into the vein) via a drip. The amount of insulin given in the drip will be altered according to “finger-prick” tests of your blood glucose aiming for stable levels between 4 and 11mmol/L. Once you are able to eat and drink, or if you are being given food (calories) through a Nasogastric tube (a small tube inserted via the nose into the stomach) and your blood glucose levels are raised, then you may be started on subcutaneous injections of insulin. It is unrealistic to expect that an ideal blood glucose level will be achieved immediately as it takes a bit of guess work initially when it comes to getting you on the right insulin regimen and the right dose. The diabetes team will visit you regularly whilst you are in hospital and may change your treatment to stabilise your blood glucose level. We will not send you home until you are established with testing your blood glucose level, you have some understanding of what it should be and until your control is satisfactory. Once you are discharged you will not be alone; in some areas there are community diabetes specialist nurses whom you can contact, in other areas it will be your GP and practice nurse that support you.

Further information

You may wish to ask further questions or seek more information about developing diabetes after pancreatic surgery. Please do ask the Diabetes Inpatient Team if you have questions. However, you may also find the following contacts helpful:

Diabetes Specialist Nurse Helpline (Hull and East Yorkshire)

Tel: 01482 675391 (Monday‐Friday 9am‐5pm). An answer machine will take a message if the Diabetes Specialist Nurse is busy with another call; please leave your name and telephone number and the Diabetes Specialist Nurse will call you back.

Diabetes UK Address:

Macleod House 10 Parkway London NW1 7AA

Website: www.diabetes.org.uk           Telephone: 020 7424 1000

E mail: info@diabetes.org.uk

Information on pancreatic cancer

Address:

Pancreatic Cancer UK

2nd Floor, Camelford House 89 Albert Embankment London

SE1 7TW

Website: www.pancreaticcancer.org.uk

Telephone: 020 3535 7099

E mail: support@pancreaticcancer.org.uk

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.